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The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on, Low energy contact X-ray brachytherapy (the Papillon technique) for early stage rectal cancer, in September 2015.

Low-energy contact X-ray brachytherapy (CXB; the Papillion technique) aims to improve local control or cure rectal cancer. The procedure involves inserting an X-ray tube through the anus and placing it in close contact with the tumour, to kill cancer cells and reduce the size of the tumour.

Low-energy CXB for rectal cancer is usually delivered in a day-care setting. The patient is given an enema before treatment, to clear the bowel. With the patient in a knee-to-chest, prone jack-knife or supine position, local anaesthesia and glyceryl trinitrate are applied to the anal sphincter to numb the area and relax the sphincter muscles. A sigmoidoscope is inserted to check the size and position of the tumour. A rigid endorectal treatment applicator is then inserted and placed in contact with the tumour. A contact X-ray tube is introduced into the applicator and treatment commences. The tube emits low-energy X-rays that only penetrate a few millimetres. This minimises damage to deeper tissues that are not involved in the cancer. If the tumour does not respond to low-energy CXB, or recurs after treatment, surgery may be performed.

What has NICE said ?

Low-energy contact X-ray brachytherapy (the Papillon technique) for early‑stage rectal cancer is safe enough and works well enough for use in the NHS for patients who cannot have surgery.

There is not much good evidence about how well this procedure works in patients who can have surgery, but have chosen not to. It should only be used if extra care is taken to explain the risks and extra steps are put in place to record and review what happens. More research on this procedure is needed and NICE may look at it again if more evidence is published.

NICE is asking health professionals to send information about everyone who has the procedure and what happens to them afterwards to the colorectal database to check how well the procedure works over time.

What does this mean for me?

Your health professional should fully explain what is involved in having this procedure and discuss the possible benefits and risks with you. In particular, if you have chosen not to have surgery, they should explain the uncertainty about the evidence on how likely it is to improve your symptoms. You should also be told about other treatment options, given written information and told how to find more information about the procedure. You should only be asked if you want this procedure after having this discussion. Your health professional should ask you if details of your procedure can be collected.

For more information please see the full article published by NICE  - NICE Papillon Guideline


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